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05070104 (2) CITY OF CUPERTINOar'-7ar'; I' ^`� Sr''� BUILDING DIVISION PERMIT COW kTQR INFORMATIONN BUILDING ADDRESS: DRAIN DOCTOR PERMRNOO5070104 OWNER'S NAME: PERMIT'ISSUE DATE JACKSON 1411ANC 1E: SANITARY NO. CONTROL NO. (408) 370-30R2 ARCHTTECTIENG - ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 u00 LICENSED CONTRACC)R'SDECLARATION Job mC I Wreby affirm that 1 am Iiansed under provision of Chapter 9(commencingLED iW with Sation)0007 of Division Softie Buaitr..eM Prafcssiu na do liccnc is �„ imm�forceAnde(fm REPLACE SEWER LINE p jjz License Class I.M.0 L C"o Dau -Contrsctor /��- t ./7 )�UG%O(�^ / full HITECI'S DECLARATI • - f / / 2005 By�� -- 1 undc�tandpy plans shat Rncards {y■pB JiU // v — aTMm �u��®I• p�`�� s o Licensed c r nal 3 OWNER-BUILDER DECLARATION I hereby shoo than I am exempt from Ne Conmemfs Licenx Law for the no following reason.(Section 7031.5,Business and Profession Cods:Any city or county which requites a permit to construct,alter.improve.dermimh.or rehab any structure prior to its issuance.also requms the applicant per such permit to file a signed suemm, onn < that he is licensed pursuant hs the provisions of the Connector's License Law(Chapter 9 Sq.Ft.Floor Area Valuation ireFm (commencing with Seamon 7")of Division 3 of the Business and Professions Codc)ter i $ that he U exempt therefrom and the baso for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the Applicant 0 A civil penalty Of 3 9&NM11n0Qr0 0 Occupancy Type not more than five hundred dollars($5(10). D I,as Ownerof0tepmpwy,ormyemploycnwithwagmoftbmlecomp melon, will do the work,And the swcmre i,not intended ter offered forsalc(Sce.70x4,Business and Prefessmos Code:The Conuacwrs License U.does nor apply to an owner of Required Inspections property who Wilde or improves thermn,and who doessuchworkhimself orthrough his awn employcn,provided that Such improvements are not intended oro0ered fors,le.IL however,the building or improvement is sold within one year ofcompletion.the owner builder will have tha W rden of proving that he dial ret Wild or improve for purpose of Sale.) . D 1.as Owner of the property,am exclusively contracting with licensed contractors by convect Ne project(Sec.7014,Business and Profession Code:)The COnuacrefs Li. Sense law don not apply in an ownm of property who Wilds or improves themon.and. who contracts for such pmjecu with A contracmr(s)licensed pursuant to the Contractors License Law. D 1 am exempt under Sec. .B&P C for this mann Owner Dau 737MWORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following decimation: have and will maintain a Certificate Of Consent self-insure for WorkersCompcn- n,ss provided for by Section 3700 of Ne labor Code,for the performance of the for which this permit is issued. have and will maintain Worker's Compensation Insurance,as rcgvired by Section ofthe Labor Code,far the performance of the weak for which this permit is issuedWorked Cnmpen6 In�nnj�e YtO�cynumberam: I ier LANV11sd Ya"H"MC nlicy No.:�L..�=// ✓,S `- CERTIFICATE OF EXEMPTION FROM WORKERS' - COMPENSATION INSURANCE (This section need not W completed tribe permit is foronc hundred dollars(S O(h) or less.) I certify the,in the Kolmmencc of the work for which this Permit is issued,l mail nm employ any person in any manner m as to Wcomc subjauo the Workcn'Compensation Law,of California.Date Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you Should become subject m the Worker's Compensation previsions Of Ne tabor Code,you must ,JZ forthwith comply with such provisions or this perm it shall W deemed revoked. z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a mnwetinr lending agency for the performance of [� the..,it for which this permit is issued(Sec.3041,Civ.C.) QLendcfs Name Z Lenders Address U C) I Certify than 1 base mad this application and sou that d¢above information IS IS, Ewren.1 agree to comply with all city and county ordinances and state laws relating to CrJ' building convection,and hereby mthoric,representatives Of this City to enter upon Nc hove mentioned property for inspection purposes. f+C (We)Agra to Save.indemnify and keep hmmless the City of Cupcnim agamst h liabiliticajidgmcmu,costs and expenses which may in any way...agmml sale City U in consequence of the;noting of this remit. APPLICANT UNDERSTANDS AND W LL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. s —�— Re-roofs Signmur ApplicanbConuamor Dau HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will the applicant ter fume Wilding occupant store or handle haa4rduus material as defined by the Cupenim Munici otic,Chapter 9.12,and dte Hcalth and Safety Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. Dy. /40No Will the applicam or fume building occupant ase equipment or&vim which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air conmminanu as dcfin d by du Bay Area Air Quality Management all new materials for inspection. District, ❑Yes No I have read the baaardcus materials requirements under Chapter 6.95of the Califor- m.Hnith&Safely Code.Scction25505.25533 and 25534.1 urWCsnand dun iflW Wilding does not currently have:•renank that it is my rcaponibili,,m mufy de occupmt of the requirements wn' hmnu WmeI fa CeniF, nmc/�. _ mature of Applicant Date —/ Owner or .,cm Dam All roof coverings to be Class"B" or better a Izcd r Community Development 10300 Torre Avenue Cupertino CA 95014 " Telephone(408)777-3228 CITY OF Fax(408)777-3333 doUPERTINO Building De artment JOB ADDRESS: L f /� PERMIT # f �- \i° 7 l/�IDOL' l V -rO -7 61d �t OWNER'S NAME: -j r Itxv o v 01 ti PHONE # Llo g Z 1 -605 GENERAL CONTRACTOR: I' v/� v >^ FAX # I am not using any subcontractors: ( — 7`- 02 0� Signature Date Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock • Tile Owner/Contractor Signature Date INVOICE. INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: kiersaw Sec: Twp: Rug: Sub: Blk: Lot: APN . . . . . . . . : 35931027.00 INVOICE DATE. . . . . . : 07/18/2005 REFERENCE ID # . . . : 05070104 SITE ADDRESS . . . . . : 1152 KENTWOOD AV SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JACKSON HUANG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5839 CONTRACTOR . . . . . . . : JOHN H. LIM LIC # 24784 COMPANY . . . . . . . . . . : DRAIN DOCTOR ADDRESS . . . . . . . . . . : 1775 WINCHESTER BLVD CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 370-3082 FEE DESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE _ ____________________ ____________ ___ __________ __________ ------ --- _ Y 4119 A 39.92 0.00 39.92 PERMIT FEES . 4116 P 83 .16 0.00 83.16 SEWERS 4117 P 21.56 0.00 21.58 PLUMBNG PERMIT ISSUE 4117 P 38.37 0.00 38.37 183.03 0.00 183 .03 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING O pS0�+o►oe*�,f CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE CUPEIZTINO PERMIT APPLICATION FORM APN# ate: 5';9-3 �_ G Building Address: �:1, rye Ati - taro o GI v Owner's N Phone#: �ILso'n 4 Vag 763 Z Contractor: Q r C//r ",/^ � Phone: �� 0 v 9� License 3 l g �1 r6' t-'j- Contact: �0 3'? 3 O 2 �P�one: \ ,N c)C L p, Cupertino Business License #: V 1J T° Building Permit Info: P-e(l r,e e S w Q✓ fln— / Bldg ❑ Elect El Plumb l `Z Job Description: Residential Commercial ❑ Cost of Project: CJ C9 0 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Pip ng System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE e a e Disposal PLUMBING / BENERGY Energy BUILDING BUSLIC Business License BUILDING •